Severe Sulfonamide Hypersensitivity Reaction in a Slow Acetylator Patient

Yap, Richard L.; Mermel, Leonard A.

doi:10.1097/00019048-200112000-00008

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…4 There are multiple cases of sulfasalazine-induced DRESS reported in the literature (see table 2). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] As seen in our case, the presentation of fever and rash weeks after initiation of sulfasalazine is characteristic of DRESS. Leukocytosis, eosinophilia, and lymphadenopathy are often cited although the degree of leukocytosis in our case is significant.…”

Section: Discussionmentioning

confidence: 98%

“…Resolution with drug withdrawal alone was reported in two cases of sulfasalazine-induced DRESS with the recovery period ranging from weeks to months. 16,17 Drug withdrawal combined with albumin dialysis was reported in one severe case of sulfasalazine-induced DRESS. 6 Treatment with corticosteroids was reported in the majority of severe cases.…”

Section: Discussionmentioning

confidence: 99%

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Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine

Jose¹,

Klein²

2011

Pharmacotherapy

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Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare, severe drug hypersensitivity syndrome characterized by fever, rash, hematologic abnormalities, and systemic involvement. The pathogenesis of DRESS is unclear, but it is thought that the offending drug induces an immune mediated hypersensitivity via defects in metabolism. Severe cases of DRESS often require aggressive treatment, but current pharmacologic treatment options are limited. We report a 66 year old female who presented with fever and rash three weeks after starting sulfasalazine treatment for rheumatoid arthritis. Investigation revealed diffuse lymphadenopathy, leukocytosis, eosinophilia, and hepatitis. She was diagnosed with DRESS, sulfasalazine was discontinued, and she was treated with methylprednisolone. Her condition deteriorated,

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine

Jose¹,

Klein²

2011

Pharmacotherapy

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“…They are detoxified partially by conjugation with glutathione. The incidence of slow acetylators is 5-10% for Asian descendants [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Trimethoprim-Sulfamethoxazole-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Complicated by Acute Liver Failure

Hindosh¹,

Kotala²,

Nguyen³

et al. 2022

Cureus

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a delayed adverse drug reaction that is characterized by fever, cutaneous manifestation, enlarged lymph nodes, hematologic abnormalities, and organ involvement. Multiple medications have been reported to cause DRESS with the presentation varying from drug to drug. Some cases are mild and can be managed by stopping the causative agent along with supportive measures; however, other cases can lead to multi-organ failure requiring systemic corticosteroids and organ transplant. Acute liver failure is a rare manifestation of DRESS. We report a patient who had recently completed a course of trimethoprim-sulfamethoxazole and presented with low-grade fever, diffuse skin rash, eosinophilia, elevated liver enzymes, acute kidney injury, and thrombocytopenia. DRESS was subsequently diagnosed based on history, physical examination, and relatively negative workup for an alternate diagnosis. The patient eventually showed improvement with steroid therapy without the need for a liver transplant. Due to its pharmacogenetic susceptibility, it is essential to recommend avoiding the causative medication for the patient's family members.

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“…A metabolite of SMX, SMX-hydroxylamine (SMX-HA) is detoxified by glutathione, and in vitro studies of SMX-HA incubated with leukocytes have shown inhibition of cell proliferation, decreased antibody production, and altered T-cell function. 17,18 Future studies are needed to clarify whether interactions between TMP-SMX, Ehrlichia, and the host immune system lead to a more severe infection.…”

Section: Discussionmentioning

confidence: 99%

Ehrlichia Myocarditis in an Adolescent

Kane¹,

Fish²,

Edwards³

2012

Infectious Diseases in Clinical Practice

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Although human ehrlichiosis has been reported as a rare cause of myocarditis in adults, it has not been previously reported in children. We describe a 14-year-old boy who developed myocarditis after presenting with fever, rash, and altered mental status, later confirmed to be associated with Ehrlichia. He was treated with trimethoprimsulfamethoxazole before diagnosis, which has been associated with more severe ehrlichial disease in some reports.

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Severe Sulfonamide Hypersensitivity Reaction in a Slow Acetylator Patient

Cited by 5 publications

References 15 publications

Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine

Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine

Trimethoprim-Sulfamethoxazole-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Complicated by Acute Liver Failure

Ehrlichia Myocarditis in an Adolescent

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